The thermogenic effect of a carbohydrate feeding during exposure to 8, 12 and 27 degrees C

Thermoregulatory and Metabolic Demands of Naval Special Warfare Divers During a 6-h Cold-Water Training Dive

Introduction: Extreme environmental conditions induce changes in metabolic rate and substrate use due to thermoregulation. Cold-water full-body submersion for extended periods of time is inevitable for training and missions carried out by Naval Special Warfare divers. Anthropometric, physiologic, and metabolic data have been reported from partial immersion in cold water in non-thermally protected men; data is limited in thermally protected divers in extremely cold water. Thermoregulatory and metabolic demands during prolonged cold-water submersion in Naval Special Warfare divers are unknown. Objective: Assess thermoregulatory and metabolic demands of Naval Special Warfare divers surrounding prolonged cold-water submersion. Materials and Methods: Sixteen active-duty U.S. Navy Sea Air and Land (SEAL) operators tasked with cold-water dive training participated. Divers donned standard military special operations diving equipment and fully submerged to a depth of ∼ 6 m in a pool chilled to 5°C for a 6-h live training exercise. Metabolic measurements were obtained via indirect calorimetry for 10-min pre-dive and 5-min post dive. Heart rate, skin temperature, and core temperature were measured throughout the dive. Results: Core temperature was maintained at the end of the 6-h dive, 36.8 ± 0.4°C and was not correlated to body composition (body fat percentage, lean body mass) or metabolic rate. SEALs were not at risk for non-freezing cold injuries as mean skin temperature was 28.5 ± 1.6°C at end of the 6-h dive. Metabolic rate (kcal/min) was different pre- to post-dive, increasing from 1.9 ± 0.2 kcal/min to 2.8 ± 0.2 kcal/min, p < 0.001, 95% CI [0.8, 1.3], Cohen's d effect size 2.3. Post-dive substrate utilization was 57.5% carbohydrate, 0.40 ± 0.16 g/min, and 42.5% fat, 0.13 ± 0.04 g/min. Conclusion: Wetsuits supported effective thermoprotection in conjunction with increase in thermogenesis during a 6-h full submersion dive in 5°C. Core temperature was preserved with an expected decrease in skin temperature. Sustained cold-water diving resulted in a 53% increase in energy expenditure. While all participants increased thermogenesis, there was high inter-individual variability in metabolic rate and substrate utilization. Variability in metabolic demands may be attributable to individual physiologic adjustments due to prior cold exposure patterns of divers. This suggests that variations in metabolic adjustments and habituation to the cold were likely. More work is needed to fully understand inter-individual metabolic variability to prolonged cold-water submersion.

Examining the benefits of cold exposure as a therapeutic strategy for obesity and type 2 diabetes

The pathogenesis of metabolic diseases such as obesity and type 2 diabetes are characterized by a progressive dysregulation in energy partitioning, often leading to end-organ complications. One emerging approach proposed to target this metabolic dysregulation is the application of mild cold exposure. In healthy individuals, cold exposure can increase energy expenditure and whole body glucose and fatty acid utilization. Repeated exposures can lower fasting glucose and insulin levels and improve dietary fatty acid handling, even in healthy individuals. Despite its apparent therapeutic potential, little is known regarding the effects of cold exposure in populations for which this stimulation could benefit the most. The few studies available have shown that both acute and repeated exposures to the cold can improve insulin sensitivity and reduce fasting glycemia in individuals with type 2 diabetes. However, critical gaps remain in understanding the prolonged effects of repeated cold exposures on glucose regulation and whole body insulin sensitivity in individuals with metabolic syndrome. Much of the metabolic benefits appear to be attributable to the recruitment of shivering skeletal muscles. However, further work is required to determine whether the broader recruitment of skeletal muscles observed during cold exposure can confer metabolic benefits that surpass what has been historically observed from endurance exercise. In addition, although cold exposure offers unique cardiovascular responses for a physiological stimulus that increases energy expenditure, further work is required to determine how acute and repeated cold exposure can impact cardiovascular responses and myocardial function across a broader scope of individuals.

Shivering thermogenesis in humans: Origin, contribution and metabolic requirement

As endotherms, humans exposed to a compensable cold environment rely on an increase in thermogenic rate to counteract heat lost to the environment, thereby maintaining a stable core temperature. This review focuses primarily on the most important contributor of heat production in cold-exposed adult humans, shivering skeletal muscles. Specifically, it presents current understanding on (1) the origins of shivering, (2) the contribution of shivering to total heat production and (3) the metabolic requirements of shivering. Although shivering had commonly been measured as a metabolic outcome measure, considerable research is still needed to clearly identify the neuroanatomical structures and circuits that initiate and modulate shivering and drives the shivering patterns (continuous and burst shivering). One thing is clear, the thermogenic rate in humans can be maintained despite significant inter-individual differences in the thermogenic contribution of shivering, the muscles recruited in shivering, the burst shivering rate and the metabolic substrates used to support shivering. It has also become evident that the variability in burst shivering rate between individuals, despite not influencing heat production, does play a key role in orchestrating metabolic fuel selection in the cold. In addition, advances in our understanding of the thermogenic role of brown adipose tissue have been able to explain, at least in part, the large inter-individual differences in the contribution of shivering to total heat production. Whether these differences in the thermogenic role of shivering have any bearing on cold endurance and survival remains to be established. Despite the available research describing the relative thermogenic importance of shivering skeletal muscles in humans, the advancement in our understanding of how shivering is initiated and modulated is needed. Such research is critical to consider strategies to either reduce its role to improve occupational performance or exploit its metabolic potential for clinical purposes.

Maintaining thermogenesis in cold exposed humans: relying on multiple metabolic pathways

In cold exposed humans, increasing thermogenic rate is essential to prevent decreases in core temperature. This review describes the metabolic requirements of thermogenic pathways, mainly shivering thermogenesis, the largest contributor of heat. Research has shown that thermogenesis is sustained from a combination of carbohydrates, lipids, and proteins. The mixture of fuels is influenced by shivering intensity and pattern as well as by modifications in energy reserves and nutritional status. To date, there are no indications that differences in the types of fuel being used can alter shivering and overall heat production. We also bring forth the potential contribution of nonshivering thermogenesis in adult humans via the activation of brown adipose tissue (BAT) and explore some means to stimulate the activity of this highly thermogenic tissue. Clearly, the potential role of BAT, especially in young lean adults, can no longer be ignored. However, much work remains to clearly identify the quantitative nature of this tissue's contribution to total thermogenic rate and influence on shivering thermogenesis. Identifying ways to potentiate the effects of BAT via cold acclimation and/or the ingestion of compounds that stimulate the thermogenic process may have important implications in cold endurance and survival.

Effects of two glucose ingestion rates on substrate utilization during moderate-intensity shivering

Although the importance of food consumption to survive in the cold is well established, most shivering studies have focused on fuel selection in fasting subjects. Therefore, the aim of the present study was to provide the first estimates of exogenous glucose as well as liver and muscle glycogen oxidation rates of non-cold acclimatized men (n = 6) ingesting glucose in trace amounts (Control; C), and at rates of 400 mg min(-1) (Low Glucose; LG), and 800 mg min(-1) (High Glucose; HG) during moderate-intensity shivering (~3 times resting metabolic rate or ~20% VO(2max)) using indirect calorimetry and stable isotope methodologies. Exogenous glucose oxidation peaked at ~200 mg min(-1) at the lowest glucose ingestion rate (~400 mg min(-1)). In addition, glucose ingestion increased the contribution of plasma glucose to total heat production by ~50% but did not change the role played by muscle glycogen (~27% of heat production for control condition and ~23-28% for LG and HG). Instead, the contribution of liver-derived glucose to total heat production was reduced by 40-60% in LG and HG, respectively. In conclusion, glucose ingestion even at low rates contributes a significant proportion of total heat production during moderate intensity shivering and reduces the utilization of liver-derived glucose but not muscle glycogen.

Shivering in the cold: from mechanisms of fuel selection to survival

In cold-exposed adult humans, significant or lethal decreases in body temperature are delayed by reducing heat loss via peripheral vasoconstriction and by increasing rates of heat production via shivering thermogenesis. This brief review focuses on the mechanisms of fuel selection responsible for sustaining long-term shivering thermogenesis. It provides evidence to explain large discrepancies in fuel selection measurements among shivering studies, and it proposes links between choices in fuel selection mechanism and human survival in the cold. Over the last decades, a number of studies have quantified the contributions of carbohydrate (CHO) and lipid to total heat generation. However, the exact contributions of these fuels still remain unclear because of large differences in fuel selection measurements even at the same metabolic rate. Recent advances on the mechanisms of fuel selection during shivering provide some plausible explanations for these discrepancies between shivering studies. This new evidence indicates that muscles can sustain shivering over several hours using a variety of fuel mixtures achieved by modifying diet (changing the size of CHO reserves) or by changing muscle fiber recruitment (increasing or decreasing the recruitment of type II fibers). From a practical perspective, how does the choice of fuel selection mechanism affect human survival in the cold? Based on a glycogen-depletion model, estimates of shivering endurance show that, whereas the oxidation of widely different fuel mixtures does not improve survival time, the selective recruitment of fuel-specific muscle fibers provides a substantial advantage for cold survival. By combining fundamental research on fuel metabolism and applied strategies to improve shivering endurance, future research in this area promises to yield important new information on what limits human survival in the cold.

Fuel selection in shivering humans

Heat exchange has been thoroughly studied in cold-exposed humans, but the metabolic substrates used for thermogenesis have received less attention. This review deals with oxidative fuel selection in shivering humans. Lipids provide most of the heat during low-intensity shivering, whereas carbohydrates become dominant under more extreme cold conditions. The contribution from plasma glucose always remains minor, but muscle glycogen plays an important role during intense shivering. Whether the size of muscle glycogen stores influences endurance in the cold remains to be demonstrated. The fuel selection patterns of shivering and exercise are different, but the mechanisms underlying this difference have not been investigated. The simultaneous measurement of metabolic substrate oxidation and muscle fibre recruitment has allowed to characterize two different mechanisms of fuel selection in shivering humans: the recruitment of different pathways within the same fibres and of different fuel-specific fibres within the same muscles. This suggests that muscle fibre composition of each individual may affect survival. Future research promises to provide a combination of theoretical advances on fundamental principles of fuel selection and applied strategies to manipulate fibre composition (through training) or fuel metabolism (through diet) to prolong human survival in cold environments.

Partitioning oxidative fuels during cold exposure in humans: muscle glycogen becomes dominant as shivering intensifies

The effects of changes in shivering intensity on the relative contributions of plasma glucose, muscle glycogen, lipids and proteins to total heat production are unclear in humans. The goals of this study were: (1) to determine whether plasma glucose starts playing a more prominent role as shivering intensifies, (2) to quantify overall changes in fuel use in relation to the severity of cold exposure, and (3) to establish whether the fuel selection pattern of shivering is different from the classic fuel selection pattern of exercise. Using a combination of indirect calorimetry and stable isotope methodology, fuel metabolism was monitored in non-acclimatized adult men exposed for 90 mins to 10 degrees C (low-intensity shivering (L)) or 5 degrees C (moderate-intensity shivering (M)). Results show that plasma glucose oxidation is strongly stimulated by moderate shivering (+122% from L to M), but the relative contribution of this pathway to total heat generation always remains minor (< 15% of total heat production). Instead, muscle glycogen is responsible for most of the increase in heat production between L and M. By itself, the increase in CHO oxidation is responsible for the 100 W increase in metabolic rate observed between L and M, because rates of lipid and protein oxidation remain constant. This high reliance on CHO is not compatible with the well known fuel selection pattern of exercise, when considering the relatively low metabolic rates elicited by shivering (approximately 30% for M). We conclude that shivering and exercise of similar energy requirements appear to be supported by different fuel mixtures. Investigating the physiological mechanisms underlying why a muscle producing only heat (shivering), or significant movement (exercise), shows a different pattern of fuel selection at the same power output strikes us as a fascinating area for future research.

Effect of cold exposure on fuel utilization in humans: plasma glucose, muscle glycogen, and lipids

The relative roles of circulatory glucose, muscle glycogen, and lipids in shivering thermogenesis are unclear. Using a combination of indirect calorimetry and stable isotope methodology ([U-13C]glucose ingestion), we have quantified the oxidation rates of these substrates in men acutely exposed to cold for 2 h (liquid conditioned suit perfused with 10 degrees C water). Cold exposure stimulated heat production by 2.6-fold and increased the oxidation of plasma glucose from 39.4 +/- 2.4 to 93.9 +/- 5.5 mg/min (+138%), of muscle glycogen from 126.6 +/- 7.8 to 264.2 +/- 36.9 mg glucosyl units/min (+109%), and of lipids from 46.9 +/- 3.2 to 176.5 +/- 17.3 mg/min (+376%). Despite the observed increase in plasma glucose oxidation, this fuel only supplied 10% of the energy for heat generation. The major source of carbohydrate was muscle glycogen (75% of all glucose oxidized), and lipids produced as much heat as all other fuels combined. During prolonged, low-intensity shivering, we conclude that total heat production is unequally shared among lipids (50%), muscle glycogen (30%), plasma glucose (10%), and proteins (10%). Therefore, future research should focus on lipids and muscle glycogen that provide most of the energy for heat production.

Effect of body composition on metabolic responses to carbohydrate feeding in males during exposure to 8, 12, and 27 degrees C

The effect of body composition on thermoregulation in response to a feeding regime was evaluated in eight male volunteers (21-27 years of age) during 120 min of exposure at 8, 12, and 27degrees C. Subjects were divided with respect to body fat [high fat (HF) = 19-28%, N = 4: low fat (LF) = 10-15%, N= 4] and randomly assigned the three air temperature conditions twice to examine the thermogenic effect of a sequential timed feeding regime of either a carbohydrate (CHO) or placebo (PL) beverage during exposure. Tissue insulation (I), rectal temperature (T(re)), mean skin temperature (T(sk)), metabolism (M), and respiratory exchange ratio (R) were examined. T(re), T(sk), M, and I revealed no significant differences between treatment (PL vs. CHO) at any temperature (8, 12, or 27 degrees C). However, pooled T)(sk) at 27 degrees C, and pooled I at 12 degrees C revealed significant (p < .05) differences between the LF and HF groups. In addition, at 8, 12, and 27 degrees C, pooled T(re), T(sk), and I decreased (p < .05) during the length of exposure, whereas pooled M increased (p < .05) at 8 and 12 degrees C. Pooled R increased during the length of exposure (p < .05) at 8 and 12 degrees C and differed (p < .05) between the LF and HF groups at 8 degrees C only. From these data, it appears that whereas substrate utilization differed between dietary treatment (8 degrees C) and across time (8 and 12 degrees C), there was a differential effect between LF and HF groups (T(sk) at 27 degrees C and I at 12 degrees C) that was not influenced by feeding regime.